TABLE 2.
Hormonal Contraceptives and ACL Injurya
| First Author, Date, Study Design (Quality) | Population (Sample Size, n) | Methods of Determining Cycle Phase and OC Use | On Hormonal Contraception | Off Hormonal Contraception | Findings |
|---|---|---|---|---|---|
| Agel,2 2006, cohort (poor) | NCAA women’s soccer and basketball players (n = 3150) | Reported by athletic trainers to centralized injury surveillance system | Injury: 16/1124 (1.42%) | Injury: 29/2026 (1.43%) | Hormonal contraceptive use had no effect on ACL injury |
| Rahr-Wagner,42 2014, case-control (good) | Women with operatively treated ACL injury registered in the Danish Knee Ligament Reconstruction Registry (n = 4497 cases; 8858 controls) | Danish Knee Ligament Reconstruction Registry linked to Danish Prescription Registry records for 5 years preceding date of injury | Cases: 2047/4497 (45.5%) Controls: 4218/8858 (47.6%) | Cases: 2450/4497 (54.5%) Controls: 4640/8858 (52.4%) | OC use decreased risk of operatively treated ACL injury for long term RR 0.80 (95% CI, 0.74-0.91) and recent OC users RR 0.81 (95% CI, 0.72-0.89) |
| Ruedl,44 2009, case-control (poor) | Female recreational alpine skiers (n = 93 cases; 93 controls) | MRI confirmed ACL, with questionnaire for OC use and cycle phase | Cases: 32/93 (34.4%) Controls: 33/93 (35.5%) | Cases: 61/93 (65.6%) Controls: 60/93 (64.5%) | OC use had no effect (0.95, 95% CI, 0.52-1.74) |
| Wojtys,54 2002, case series (poor) | High school or college-aged women with ACL injuries (n = 65) | Urine assays and questionnaire | 14/65 (21.5%) | 51/65 (78.5%) | Women not taking OCs sustained more injuries during the ovulatory phase (χ2 = 29.8; P < .0001). Women taking OCs demonstrated no change in risk (χ2 = 2.38; P = .7) |
| Lefevre,33 2013, case series (poor) | Female skiers with ACL injuries (n = 172) | Questionnaire | 53/172 (30.8%) | 119/172 (69.2%) | OC use had no effect on ACL injury rates (85/119 [71.4%] OC vs 36/53 no OC, OR, 1.18; 95% CI, 0.59-2.38; P = 0.64]) |
| Arendt,3 2002, cohort (poor) | Female collegiate athletes (n = 83) | Reported by athletic trainers to centralized surveillance system | 20/25 (80%) | 54/58 (93%) | OC users had a greater difference between high- and low-risk periods of ACL injury, but OC use did not change the period of high risk (follicular) |
| Gray,20 2015, case-control (fair) | Females with ACL injury, aged 15-39 years (n = 12,891 cases; 38,457 controls) | ICD-9-CM procedural codes applied to a national insurance claim database | Cases: <90 d of use: 598/12,891 (4.6%) >90 d of use: 2408/12,891 (4.7%) Controls: <90 d of use: 1911/38,457 (5.0%) >90 d of use: 6864/38,457 (17.8%) | Cases: 9885/12,891 (76.7%) Controls: 29,682/38,457 (77.2%) | OC use decreased risk of ACL reconstructions in women 15-19 y (adjusted OR, 0.82; 95% CI, 0.75-0.91; P = .0001) OC use higher in older age groups 25-29 and 30-34 y (adjusted OR, 1.15; 95% CI, 1.02-1.30; P < 0.05 and 1.16; 95% CI, 1.04-1.31; P < .05) |
aACL, anterior cruciate ligament; ICD-9-CM, International Classification of Diseases Ninth Revision Clinical Modification; MRI, magnetic resonance imaging; NCAA, National Collegiate Athletic Association; OC, oral contraceptive; OR, odds ratio; RR, relative risk.